Description & Habits

The head louse is a tiny, soft-bodied insect that is somewhat flat.
The adult stage is approximately 1/16 inch
long—about the size
of a sesame seed. Immature stages (nymphs) are smaller. The head louse has a
narrow head that is equipped with sucking mouthparts. Individuals often are
grayish-white to tan but may become reddish-brown after feeding on
human blood.
The head louse is wingless and has six legs, each ending in a small
claw (hook)
that is designed for grasping hairs. These claws are better able to
grasp hair
that is round in cross-section, which is typical of Caucasians.
Adults and nymphs
use their claws to cling to hair, and they do not fall off hair easily.

Fig.1. A head louse (left) and crab louse (right) are
distinctly different.

Head lice do not jump, hop, or fly. They do crawl a lot, and they can move
quickly. They may be found anywhere on the human scalp and hair.
The most typical
locations are the crown of the head, above and behind the ears, and the nape
of the neck.

Lice eggs are referred to as nits. Nits are oblong and usually pearly white, but they may darken to a tan or coffee-color as the young louse completes its development within the egg and nears hatching. Each nit is about 1/30 inch long (less than the width of a #2 pencil lead). Each nit is attached (cemented) onto a hair shaft, typically very close to the scalp. Although nits are laid close to the scalp, they eventually may be found further down the hair shaft as the hair grows and elongates. Nits may occur on any region of the head, but often are found behind the ears or near the hairline at the back of the neck. Nits are not easily dislodged, and they may remain attached to hair strands that have been shed.

Life Cycle

The head-louse life cycle (egg to adult) requires about 21-27 days on
the human host. Each adult female deposits anywhere from
50-150 eggs (nits)
during her lifetime. Nits hatch in 5-9 days. Nymphs (immatures) molt
three times
before becoming sexually mature adults. Young and adult head lice
feed on blood
several times a day. The adult stage can live approximately one
month (30-40
days).

Fig.1. Head louse life cycle.

Head lice are completely dependent on their human host for nourishment and warmth. In fact, head lice cannot complete their life cycle if they become separated from their host. Adults and nymphs can survive off their host for only 2-3 days, whereas nits can live for up to 14 days.

Injury

When a head louse inserts its mouthparts into human skin to obtain blood, it
injects saliva that may cause intense irritation and subsequent
itching of the
scalp. Children less than 12 years old typically are more sensitive
to head-lice
bites than older children and adults.

Scratching of head-lice bites increases inflammation, sometimes leading to secondary bacterial infections. However, head lice are not known to be responsible for the direct spread of disease organisms.

Symptoms

Constant itching and scratching of the scalp often is the first outward sign
that a person has head lice. However, some individuals are not sensitive to
head-lice bites and may experience no symptoms.

Head lice also may be indicated if one finds tiny, black spots on bed pillows, sheets, or clothing near the neckline and shoulders. These black spots consist of digested blood excreted by a head louse after feeding.

Detection

Because of their tiny size, head lice and nits often are detected with the
aid of a hand lens or magnifying glasses. (Magnifying glasses are
most helpful
because both hands are free to inspect the hair.) High-intensity
lighting, even
natural sunlight, is very helpful for detecting nits. However,
adults and nymphs
move very quickly away from a light source and its associated warmth.

Head lice may look like grayish specks moving rapidly on the scalp and hair. Diagnosis based on adult and immature stages is difficult; they are easily overlooked. A head-lice infestation is most often diagnosed by observing the stationary nits glued to hair shafts very near the scalp. Nits may look like dandruff, but they cannot be shaken off.

Spread of Head Lice

Head lice are spread from people who have head lice. Direct,
head-to-head contact
with an infested person is the most common way head lice are
spread. Head lice
also may be transmitted by sharing infested items. Such articles
commonly implicated
in the spread of head lice include hair-care items and
accessories such
as combs, hairbrushes, headbands, ribbons, barrettes, hair rollers,
wigs, etc.;
head gear such as helmets, headsets, ear phones, etc.; clothing
items, including hats, caps, scarves, sweaters, costumes, etc.; and sleep
items such as pillows, bed linen, stuffed animals, etc.

Lice can be transferred from coats, sweaters, scarves, hats, etc. contacting each other in cloakrooms, closets, and lockers. Placing your head where someone with head lice has recently laid theirs, such as on a couch, rug, mattress, bus seat, airplane seat, car seat, etc. also can result in the spread of head lice.

Prevention of Head Lice

Routine hair inspections at school and at home are very important
to long-term
prevention of head lice. When head lice remain undetected and
untreated, their
population only continues to grow. Children, parents, caregivers, educators,
etc. need to be involved in the solution to the head-lice
condition. They should
know how to prevent the spread of head lice, how to inspect for
them, and what
treatment procedures should be followed.

As a precaution against spreading head lice, avoid sharinghair-care
items and accessories, such as combs, hairbrushes, headbands,
ribbons, barrettes,
hair rollers, wigs; head gear such as helmets, headsets, ear phones;
clothing items, including hats, caps, scarves, sweaters, costumes;
and sleep
items such as pillows, bed linen, stuffed animals, etc. Coats, sweaters,
scarves, hats, etc. should not contact each other in cloakrooms, closets, and
lockers. If storage space is limited, an option is to put each
person’s coats,
sweaters, hats, etc. in a separate plastic bag marked with their
name. Placing
each person’s personal items in a separate bag, particularly while
dealing with
a head-lice episode, will not call undue attention to any one individual that
has head lice.

Education is an important tool to dispel myths and fears often associated with head lice. Teach and encourage that the condition is not “the plague!” Head lice are just pesky insects that nobody likes, but any infestation needs to be dealt with immediately. Head lice quickly spread when people don’t notice the condition and do not seek early treatment. Informed children, parents, and caregivers realize the importance of immediately communicating any findings of head lice. Early detection and proper action allow faster eradication and reduces the spread of head lice.

Control Measures Using an Integrated Pest Management (IPM) Approach

A variety of control measures should be implemented
immediately, because
person-to-person contact can result in rapid spread of head lice to others in
the school, family, and workplace. The earlier a head-lice
infestation is detected,
the faster it is to solve the problem.

It is important to concurrently take steps to eradicate head lice from the environment and the person. A stubborn cycle of repeated infestations can result if such control efforts are not made at the same time.

Some Steps to Eradicate Head Lice in the Environment

Chemical Sprays:

Treating the environment with insecticide sprays is not necessary and is
not recommended since head lice can only live a short time
apart from their
human host. Furthermore, such chemicals have little, if any, impact
on the nits.
Insecticide sprays also should not be used on the body or clothing
if you have
head lice. Use of chemical sprays results in unnecessary exposure
to insecticides.

Thorough vacuuming is a safe, effective way to remove head lice
from the environment.
In addition to vacuuming all floors, be sure to vacuum mattresses,
stuffed animals,
upholstered furniture, rugs, car seats, etc. Immediately after
vacuuming, seal
the vacuum cleaner bag in a plastic bag, then throw it away in an
outside trash
receptacle.

Washing Items, Bagging Items:

It is important to isolate or sanitize any personal items that
could be infested
with head lice. Such items can be sealed within a plastic trash bag
for at least
14 days. This is a good alternative for items that cannot be washed
(dry-clean
only quilts, pillows, stuffed animals, etc.). If items such as
combs, hair clips,
barrettes, etc. can tolerate chemicals or heat, place them in
undiluted isopropyl
alcohol for approximately 20 minutes or in a solution comprised of 1 teaspoon
of ammonia added to 2 cups of hot water for 15 minutes. Or, you can boil them
in water 10–15 minutes. As a last resort, throw away the infested items.

130 – 140° F

Bedding, clothing, towels, and other washable items that have been in contact with an infested individual should be washed and dried at hot temperatures. These items should be washed for at least 10 minutes at a water temperature of 130–140° F. To reach this desired temperature, you may need to temporarily raise the temperature of the water heater. (To avoid burns, remember to turn the water heater back down to a lower temperature after the lice ordeal.) Wait between washings until the appropriate temperature is reached. Place washed items in a drier set at the highest suitable temperature. Dry for at least 20 minutes.

Some Steps to Eradicate Head Lice on the Person

Effective head-lice control includes specific measures against the egg stage
(nit) as well as against the adult and nymphal stages. Just a few undetected
nits, adults, or nymphs can result in a full-blown infestation of head lice.
Nit-picking (egg removal) can be done either before or after use of
an insecticidal
or non-insecticidal treatment, which primarily kills head-lice
adults and nymphs.

Extermination of Nits on Hair

Nit-picker is a term associated with head-lice infestations. In fact, nit-picking is essential to head-lice eradication on the person, because nits are firmly attached or cemented to hair strands and are quite difficult to remove. Nits also tend to be more difficult to kill than adults or nymphs. The nervous system, which typically is the target of insecticide treatments, is incompletely developed during the egg stage of the head louse.

Head lice are very tiny, parasitic insects. They inhabit the hair and scalp
of humans. Head lice feed only on human blood, which they require
for nourishment.
Head lice do not infest pets or livestock.

Despite common misconceptions, head lice can affect people of all ages, rich
or poor. Head lice do not reflect one’s socioeconomic status or social
class. Furthermore, head lice are not signs of uncleanliness. Regular washing
of the body or hair will not prevent head lice.

Head lice are spread from people who have head lice. Direct,
head-to-head contact
is the main way head lice are spread, but they also may be
transmitted by sharing
infested items such as hair-care items and clothing. Head lice can
be considered
a communicable disease, somewhat comparable to the common cold.

These tiny insects can be a major pest problem. Infestations can
spread quickly
among individuals. Head lice are big inconveniences, typically
requiring weeks
of periodic intervention and surveillance to combat an infestation.

Pediculosis is the medical term for a lice infestation. This is an inclusive
term that does not distinguish among the various types of human lice, such as
body lice and crab lice. Head lice are distinctly different from these other
types of lice that occur on humans.Body lice
typically are found
attached to clothing fibers. They periodically move to the human body to feed
on blood. Body-lice infestations flourish in overcrowded,
unsanitary conditions
where clothing is not changed regularly. Crab lice are found primarily in the
pubic region, where they feed on human blood. Crab lice are
sexually transmitted.

Fig.1. Nit (egg), 1/32
inch

Fig.2. Adult head louse ,
1/16 inch

Although head lice can infest humans of any age, they most
commonly occur among
children that have close contact with each other at school and at play. About
5 to10 percent of all school children contract head lice at one
time or another.
Head lice ultimately are a community problem.

Educators, parents, and children need to understand that absolutely no shame should be associated with having head lice. How school educators handle the situation will greatly affect how the students treat each other. Do not call undue attention to any person having head lice. For example, it is not necessary to shave the hair. Anyone can get head lice—even you!

Nit Combs

A specialized nit comb is an important tool when nit-picking. A regular hair
comb will not remove head lice and nits. The best nit combs have
closely spaced,
metal teeth that are about 1–1/2 inches long (i.e.,
Acu-Med®
lice comb, Hair Clean® 1-2-3 nit comb,
LiceMeister®
nit comb).

A variety of nit combs are packaged with head-lice products, and others are
sold separately (available at some pharmacies). However, many of
these are ineffective.
Plastic combs are not useful because they are so flexible that the
teeth separate,
and nits and head lice are bypassed as the comb is dragged through the hair.
With a short-toothed comb, it is difficult to completely comb
through most types
of hair.

Fig.1. Lice Comb

Nit-Picking Step–by–Step

The initial steps as a nit-picker are to take several precautions to protect
oneself from inadvertent transfer of head lice from the infected person. Make
sure that you do not touch your hair while nit-picking. If necessary, secure
your hair with hair clips, bobby pins, etc. or tie it back. Remove
all jewelry
from your hands and wrists (rings, watch, bracelets, etc.). Wear
short sleeves.
A convenient, inexpensive way to protect one’s clothing is with a disposable
apron cut from a large garbage bag such that it is open in the back and has
holes to insert one’s arms. When you have finished nit-picking,
remove the apron
by folding the plastic into itselfnot by pulling it over your head.

Nit-picking is a “seek-and-destroy” mission. Be sure to have both
hands free. Disposable gloves are neither needed nor desired; they
are a hindrance
to picking nits off of the hair. Do not be afraid to search. Just
follow these
10 steps for nit-picking:

Work under bright lighting. If needed, wear magnifying glasses.

Shampoo the affected person’s hair and rinse well. An option at
this point
is to then soak the hair with non-diluted vinegar, leaving it on
for approximately
1 hour. The vinegar helps loosen the gluey substance that attaches each nit
to a strand of hair. Rinse the hair to remove the vinegar, then
shampoo, and
proceed to the next step.

Put a thick hair conditioner on the hair to detangle it and to
aid in searching
for and removing nits. This also may reduce discomfort associated
with subsequent
comb.
Figure 1.Figure 2.

It is a good idea to cover the affected person’s clothing with
a disposable
plastic apron (described on page 4) or a towel. Inspect 1-inch sections of
hair at a time (Figure 1& 2). Use a specialized nit comb and
one’s fingers
to start at the scalp (Figure 3) and drag nits to the end of the hair shaft
, then off. Nits are particularly difficult to see on very light,
blond hair,
and you may need to feel along the hair shaft. The nits will feel
like a grain
of sand.
Figure 3.Figure 4.

After inspecting each small section of hair, wipe the comb with a moist
tissue, which then should be placed in a bowl of hot, soapy water (Figure
4). Periodically flush the contents down the toilet.
Figure 5.Figure 6.

Curl up the inspected 1-inch section of hair with a bobby pin,
then inspect
an adjacent section (Figure 5).

Keep combing and nit-picking until all of the hair has been inspected and
no more nits are seen (Figure 6).

Remove the bobby pins, then shampoo the hair thoroughly and
rinse well.

When you have finished, throw away any materials used during the process
or sanitize them as outlined above. (See Some Steps to
Eradicate Head Lice
in the Environment.)

After the major “seek-and-destroy” mission, inspect the entire family every day for at least 14 days. Proper treatment of the individual, their belongings, and the environment does not ensure against possible re-infestation from an outside source. Each time that head lice or nits are found, start nit-picking again as outlined above.

Extermination of Head Lice Adults and Nymphs on Hair:

Use either an insecticidal or an alternative, non-insecticidal treatment on
the hair to kill the head-lice adults and nymphs. Regardless of the approach,
it also is necessary to concurrently sanitize the environment
(vacuuming, bagging,
etc.) and nit-pick using a nit comb and one’s fingers.

Beware of false advertising and misleading claims. Available products do not prevent head lice.

Insecticidal Strategies

Although all members of the family need to be inspected for head
lice, an insecticidal
treatment for the hair should be applied only to individuals that have
been confirmed as having head lice. Do not use an insecticidal
strategy unless
head lice have been detected.

The most common way to approach head-lice control has been to use a chemical
treatment, called a pediculicide. Such treatments come in various
forms: shampoo,
cream rinse, gel, mousse, and oil spray. These products can be
quite expensive.
Even though most of these products are available without a prescription, they
contain an insecticide and should be given the same respect as a prescription
drug.

Read the label to determine the active ingredient(s).
Over-the-counter products
that list permethrin (i.e., Nix®) or pyrethrins (also known
as pyrethrum extract) contain insecticide(s). Pyrethrins often are combined
with piperonyl butoxide, a synergist that increases their activity
against head
lice; some examples include LICEX®,
RID®, Pronto®,
R&C® Lice Treatment, Clear® Lice Killing
Shampoo, etc. Ovide® is a prescription-only product
that contains
the insecticide malathion.

Lindane (Kwell®) is a potent insecticide that is available
only by prescription and only as a second-line treatment for people
who cannot
tolerate other chemical therapies or where other products have
failed. However,
be aware that lindane is readily absorbed through human skin, has a
long half-life,
and is relatively toxic to mammals. Use of lindane has been associated with
convulsions and seizures in humans. Because of human health concerns, lindane
is seldom recommended for head-lice control; there are many less
toxic alternatives
for head-lice control.

Resistance to the insecticides found in head-lice products is a
potential cause
of treatment failures. Resistance of head lice toward lindane has
been documented
over the years.

Several recent clinical studies also indicate that head-lice
populations have
developed varying levels of resistance to permethrin and malathion.
Resistance
currently seems to be less of a problem with pyrethrin/piperonyl
butoxide combinations.
However, be aware that lice can eventually develop resistance
toward most, perhaps
all, insecticides.

Do not keep using the same product over and over again. If
one product
is not working, try another approach or use a product that contains
a different
active ingredient. Consult your physician if you have difficulty getting rid
of the head-lice infestation.

When using any insecticidal treatment, read and closely follow all
instructions.
Be aware that over-treatment can be toxic to humans. If the treatment
is to be reapplied after 7–10 days, do so since head-lice eggs may have
hatched within this period. Do not apply the product any more or
less often
than is recommended on the label.Consult your physician
or pharmacist
if you have questions or need additional information.

Take a number of precautions prior to using an insecticidal
head-lice product.
Contact your physician for medical advice if the person applying
the treatment
or receiving the treatment is pregnant or has asthma, allergies, or any other
medical condition. Also, seek advice from your physician if the pediculicide
will contact any open cuts in the skin, such as those caused by scratching.

Use disposable rubber gloves when applying an insecticidal
product. Take care
to treat only the head, not the rest of the body of the affected person. Keep
the pediculicide out of the eyes, nose, mouth, and any mucus membranes. The
affected individual should either sit, leaning head back, or they should lie
on a cushioned counter with the hair draped into a sink or other receptacle.
They should be in a comfortable position to help avoid squirming.
(Do not apply
to the affected person’s head while they are in the tub. Do not
have them lean
their head forward, because of the increased possibility of inhaling fumes or
having the chemical contact the face.) Apply the insecticidal
product to a cool
head. Warmth opens up the pores in the skin and an excessive amount
of the chemicals
can be absorbed.

Even after taking these precautions, if the chemical solution gets in the eyes, rinse quickly and gently with lukewarm water or normal saline solution (used for rinsing contact lenses) for 10–15 minutes or more. Apply a cool, wet cloth over the closed eyes and have the individual rest. Contact your physician if visual changes occur or burning persists.

Combination (Insecticidal and Non-Insecticidal) Strategies

Some non-insecticidal products are marketed for use together with an insecticidal product. Such an approach can be expensive with the purchase of at least two products. Clear® Lice Egg Remover is a gel that contains a number of enzymes, including oxidoreductase, transferase, lyase, hydrolase, isomerase, and ligase. It is to be used after treating with Clear® Lice Killing Shampoo, which contains pyrethrum extract. LiceGuard® shampoo contains sodium laureth sulfate and is to be used after treating with a pyrethrin or pyrethrum product or the electronic LiceGuard® Robi Comb®. RID® gel contains cabbage extract and pineapple extract for dissolving the “glue” that attaches nits to hair. It is to be used following RID® shampoo, which contains pyrethrum extract.

Non-Insecticidal( Alternative) Strategies

In recent years, a number of non-insecticidal alternative products have been
developed and marketed for treatment of head lice. These head-lice products
contain chemicals that are not classified as conventional
insecticides. Furthermore,
they do not require treatment with an insecticidal product prior to
their use.
An obvious advantage is that these treatments are relatively nontoxic. It is
difficult to evaluate the effectiveness of many of these new products because
there are few published reports.

Enzymes, Extracts, Oils, Etc.

Hair Clean® 1-2-3 contains various plant oils,
such as coconut,
anise, and ylang ylang oil, which aid in removing head lice and
nits. However,
to ensure long-term success, a second application is recommended 7 days after
initial treatment. The enclosed long-toothed, metal nit comb kills the lice
due to the physical combing action. This product has been on the market for
several years. It has been evaluated in several clinical trials,
which suggest
promise for head-lice control.

Lice B Gone® contains enzymes of natural vegetable extract
that soften the glue that attaches the nits to the hair. The hair then must
be combed carefully (preferably with a metal nit comb) to remove all of the
head lice and nits. This product typically requires only one
application. Clinical
trials suggest promise for head-lice control.

Not Nice To Lice® contains enzyme cleaners with
protease, which
work to “release” the nits. This product includes a
cautionary statement
that the cleanser can cause eye irritation and should be kept out
of the eyes.

Acu-Med® Lice Cure contains tea tree oil,
ylang-ylang, eucalyptus,
and citronella. This spray helps remove lice eggs from the hair. The kit also
contains a long-toothed, metal nit comb that kills the lice due to
the physical
combing action.

Licefreee® contains natrum muriaticum, a
“homeopathic”
pediculicide. A second treatment with this gel is recommended 7–10 days
after the initial application.

LiceGuard® Head Lice Repellent Spray claims to
“help prevent
head lice infestations” with a patented CL-1 fragrance. The
spray is applied
to dry hair every 24 hours.

Electronic Devices

Electronic devices for insect control or eradication typically are
not backed
by conclusive research. In general, electronic devices are not effective in
controlling insects. The LiceGuard® Robi
Comb®
has been marketed as an electronic head-lice detector and remover.
This device
is quite expensive (approximately $40). Clinical tests have not demonstrated
the need for the electronic component; the simple mechanical action
of the comb
may be sufficient.

Miscellaneous Home Remedies

Products that are not marketed specifically for head lice typically do not
have clinical data to support their effectiveness. There are only anecdotal
(word-of-mouth) suggestions that some alternative approaches may have value
for treating head lice on hair. For the most part, there is no
reliable evidence
that oil-based treatments, conditioners, or shampoos actually kill head lice
on a person’s head. However, these products may cause the nits to
more readily
slide off the hair, and they also appear to slow down the head lice so that
they can be more easily removed with a nit comb. Such products are much less
expensive than chemical treatments.

Advocates of non-insecticidal treatments suggest that head lice
may be affected
by soaking the hair of the affected person with olive oil, vegetable oil, or
baby oil. A hair conditioner that frequently is mentioned as an alternative
treatment is Queen Helene® Cholesterol Hair
Conditioning Cream.
This hair-care product is quite thick (heavy) and clings to the
hair. The suggested
procedure is to thoroughly apply one of these oils to the hair,
then put a shower
cap on the head and leave it on overnight. The next morning,
complete the previously
described process of nit-picking with a nit comb and your fingers. Follow-up
by using a shampoo containing sodium laureth sulfate, which possibly affects
head lice. Such shampoos include Herbal Essence®,
Suave®,
White Rain®, and many others.

Be aware that any of these oil-based treatments typically require repeated
efforts with daily nit-picking until nits are no longer seen. Also,
it is necessary
to continue overnight applications if live head lice are observed.
The mechanical
action of the comb may be responsible for ultimately providing
head-lice control,
rather than simply the oil component.

The disadvantages of some alternative, oil-based treatments outweigh their
usefulness. Mayonnaise has been recommended as an alternative, but mayonnaise
will become rancid by the next morning. (Furthermore, a dog or other pet may
lick the mayonnaise, perhaps becoming ill.) Petroleum jelly is very
sticky and
quite difficult to remove from hair. Also, it is difficult to find the nits
because lint, dust, and crumbs readily cling to this sticky substance.

Do not shave the head in a desperate attempt to get rid of head lice. Head-shaving does not get rid of all of the nits, which are attached at the base of the hair shaft and extremely close to the scalp. It is needlessly upsetting to children and can have a long-term impact on their self-image and socialization. It is unnecessarily traumatic, particularly for females, to resort to such a measure. Would you and older female relatives submit to this procedure?

Dangerous Home Remedies

Do not resort to desperate measures in an attempt to kill head lice. Do not apply kerosene, gasoline, isopropyl alcohol, or lighter fluid to the hair; do not use veterinarian products, agricultural or lawn-care chemicals, and any other insecticide that is not labelled for head lice. Each year, such home remedies kill or maim some children. In misusing such products, safety is ignored. As an example, kerosene is not only extremely flammable, but it is absorbed through the skin and can be toxic, even causing death. Human safety always should be the main concern.

Conclusions

Head lice are peskyinsects that are a very big inconvenience.
They are not known to carry any disease organisms. Head lice are not
indicators of uncleanliness, and they should not be associated with
any social
stigma or embarrassment. Head lice simply are spread by people who have head
lice.

The whole experience of having head lice can be very frustrating,
particularly
to parents or caregivers. Address the issue of head lice. Do not avoid it by
ignoring it. Avoidance will only increase misconceptions, unfounded
fears, and
confusion, and thus slow efforts to stop the spread of head lice.

Successful intervention includes immediate, concurrent measures to eradicate head lice and nits from the environment and the person. Be tenacious in your fight against head lice.

Non-Prescription Insecticidal Treatments

Trade
Name(Company)

ActiveIngredientand
PercentConcentration

Type ofProduct

Awareness Issues

“Claims”a andAdditional
PackageContents

Nix®(Warner-Lambert)

Permethrin 1%

Creme rinse

May not kill nits (eggs).
Resistance has developed in many
regions of the world.

May not kill nits (eggs).
Use with caution on persons
allergic to ragweed;
contact a physician before using if allergic to
chrysanthumums and pyrethrin-containing
compounds.d

Treatment followed with nit
removal is required to ensure complete effectiveness.
Use in conjunction with
Clear® gel “to help prevent re-infestation.”
A second treatment must be done
in 7-10 days to kill any newly hatched lice.

Pronto®(Del
Pharmaceuticals Inc.)

Pyrethrum extract
0.33%c

Shampoo plus conditioner

May not kill nits (eggs).
Use with caution on persons
allergic to ragweed;
contact a physician before using if allergic to
chrysanthumums and pyrethrin-containing
compounds.d

Kit includes a “100% effective”
short-toothed plastic lice
comb,b
crème rinse packet, plastic
magnifier, and 4 hair
strand separators.
A second treatment must be done
in 7-10 days to kill
any newly hatched lice.

R & C® Lice
Treatment(Block Drug Co., Inc.)

Pyrethrum extract
0.33%c

Shampoo plusconditioner

May not kill nits (eggs).
Use with caution on persons
allergic to ragweed;
contact a physician before using if allergic to
chrysanthumums and pyrethrin-containing
compounds.d

It is important to remove all of
the nits after
shampooing.
A second treatment must be done
in 7-10 days to kill
any newly hatched lice.
Kit includes a short-toothed, plastic nit
combb

RID®(Bayer
ConsumerCare Division)

Pyrethrum extract
0.33%c

Shampoo

May not kill nits (eggs).
Use with caution on persons
allergic to ragweed;
contact a physician before using if allergic to
chrysanthumums and pyrethrin-containing
compounds.d

Use together with
Clear® shampoo,
which contains 0.33% pyrethrum extract.
Use “to help prevent
re-infestation.”
Includes a short-toothed, plastic
“exclusive
‘nit capturing’
comb.”b

LiceGuard® Shampoo
Lice Egg Remover
(ARR Health Technologies, Inc.)

Sodium laureth sulfate

Shampoo

Use after treating with a
pyrethrin or pyrethrum
product or an electronic device.
Helps remove eggs, but does not kill lice.
“Triples number of nits
removed” by
loosening the glue bond between nits and hair.
Kit includes a short-toothed,
plastic “extra
fine” nit comb.b

RID® (Bayer Consumer
Care Division)

Cabbage extract and pineapple extract

Gel

Use together with
RID® shampoo,
which contains 0.33% pyrethrum extract.
“Helps dissolve the ‘glue’
that binds eggs to hair.”
Kit includes a short-toothed,
plastic “patented
RID® egg removal
comb.”b

Prescription-Only Insecticidal Treatments

Trade
Name(Company)

ActiveIngredientand
PercentConcentration

Type ofProduct

“Claims”a andAdditional
PackageContents

Ovide® (Genderm)

Malathion 0.5%

Lotion

Effectiveness is very dependent
on inert ingredients
(excipients).
Flammable.
Very strong odor.
Resistance has developed in many
regions of the world.

Kwell®(Reed and
Carnick)

Lindane 1%

Shampoo

Can be obtained only by prescription for
2nd-line treatment.
Seldom recommended because of
health concerns.
Potential neurotoxicity to humans.
Has been associated with
seizures, convulsions, etc.
Readily absorbed by human skin.
Head lice have developed various levels of
resistance throughout the world.
May not kill nits (eggs).

aBeware of any false advertising.
Carefully read the label and all directions before purchasing
a product. It is not necessary or advisable to apply
insecticides to clothing, mattresses, or
other places in the environment for head lice control.

bPlastic nit combs typically are not
useful because the teeth tend to bend and spread apart
and thereby bypass nits and head lice; they also tend to break
easily. Short-toothed combs,
whether plastic or metal, are ineffective in combing through many
types of hair.

cPiperonyl butoxide included as a
synergist to increase insecticidal activity.

dBe aware of potential for an allergic reaction. Immediately consult a physician if an allergic response is indicated, and avoid future use.

Some Alternative (Non-Insecticidal) Head Lice Products

Trade
Name(Company)

ActiveIngredientand
PercentConcentration

Type ofProduct

Awarenessw Issues,
“Claims”a andAdditional PackageContents

Gels, Shampoos,
Sprays

HairClean 1-2-3®(Quantum)

Coconut oil, anise oil, ylang ylang oil

Spray

“Proven clinically.”
“Intended to remove and/or
kill lice and nits
from the head.*”
(“*Lice/nit death results
from physical combing action.”)
Apply product to dry hair and
leave on for 15
minutes, then use comb to remove head
lice and nits.
“To ensure long-term
success, treatment must be
repeated seven days after initial
treatment.”
Kit includes a long-toothed,
metal nit comb.

Lice B
Gone®(Safe Effective Alternatives, Inc.)

Enzymes of natural vegetable extract

Spray

“Effective in removing head
lice and nits.”
Apply product to dry hair and
leave on for a minimum
of 30 minutes in order to soften the
glue, then comb
hair carefully with a fine-tooth comb
to remove all head
lice and nits.
“Most cases require only one
application.”
Available in 4 oz. or 16 oz. (4
applications) spray
bottles.

Acu-Med® Lice Cure
(Health Enterprises, Inc.)

Tea tree oil, ylang-ylang,
eucalyptus, citronella

Spray

“All natural and non-toxic.”
“Effective in the removal of
the eggs from the
hair.”
Kit includes a long-toothed,
metal nit comb, 5x
magnifier, tweezers, and cleaning brush.

Licefreee!®(Tec
Laboratories, Inc.)

Natrum muriaticum 1x

Gel

“Homeopathic pediculicide.”
“Kills lice dead.”
Apply product to dry hair and
leave on for at least
60 minutes with a shower cap, then use a fine-tooth comb
to remove dead lice and their nits.
“A second treatment in 7-10
days to kill any
newly hatched lice is recommended.”
Kit includes a short-toothed, plastic nit
combb and 2
treatment (shower)
caps.

Not Nice To Lice®(Ginesis)

Enzyme cleaners with protease

Shampoo

“Eliminates both lice and
their eggs (nits).”
Directions specify a 4-step
application process (30
minutes), then “comb through the
hair with any fine
tooth comb to assist in removing the
nits that have been
released.”
“It is important to keep
this cleanser out of
the eyes to prevent eye irritation.”

Two designs: the ‘ultimate’ comb
and the ‘deluxe’
comb. The ‘ultimate comb’ plastic
frame holds a short-
or long-tooth metal pin insert. The
‘deluxe’ comb has a
molded plastic handle with fine metal teeth.
The ‘ultimate’ comb “works
on all hair types,
lengths and styles.”
Shampoo with a pediculicide before combing.
Can be sterilized by boiling for re-use.
A 5x magnifier, tweezers, and
cleaning brush are
included in the kit with either comb.

Do not use on wet hair or in a room with
high humidity.
Unit must be dry prior to use.
“Electronic head lice
detector and remover.”
“Electronically kills lice.”
Use at least 5 minutes daily for
about 2 weeks.

aBeware of any false advertising.
Carefully read the label and all directions before purchasing
a product. It is not necessary or advisable to apply
insecticides to clothing, mattresses, or
other places in the environment for head lice control.

bPlastic nit combs typically are not
useful because the teeth tend to bend and spread apart
and thereby bypass nits and head lice; they also tend to break
easily. Short-toothed combs,
whether plastic or metal, are ineffective in combing through many
types of hair.

cPiperonyl butoxide included as a
synergist to increase insecticidal activity.

dBe aware of potential for an allergic
reaction. Immediately consult a physician if an
allergic response is indicated, and avoid future use.

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